Notification of Changes for Business Entity
General Information
Business Entity Name:	PROMEDICA FEDERAL CREDIT UNION
Incorporation / Formation Date:
FEIN:	34-1137072
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	LUCAS
Business Address
Address 1:	2301 W CENTRAL
Address 2:
City:	TOLEDO
State:	OH
Zip:	43606
Phone:	419-479-4040
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2301 W CENTRAL
Address 2:
City:	TOLEDO
State:	OH
Zip:	43606
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
SANDRA GREENLESE	EMPLOYEE	282-72-4142	YES		1/1/18
AMANDA BERNING	EMPLOYEE	298-82-9163	YES		1/1/18
MOLLY PIERCE	EMPLOYEE	066-70-0254	YES		1/1/18
MATT DELAND	EMPLOYEE	382-90-5586	YES		1/1/18
JEN LEU	RDA	367-02-8623		YES	7/1/18
WILLIAM HANN	AGENT	275-64-5502		YES	7/1/18

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)	NO
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?	NO
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	RICHARD J HAAS JR
Title:	CEO
Phone Number:	419-479-1310
Email Address:	RHAAS@PROMEDICAFCU.COM